It can be hard to detect and treat depression when it occurs in palliative care because it often presents amongst a multitude of other symptoms.

There are obviously many systematic reviews that assess the use of antidepressants as a treatment for various life threatening illnesses, but no previous study has synthesized the evidence in palliative care. The objective of this study was to determine the efficacy of antidepressants for the treatment of depression in this specialised area of healthcare that focuses on relieving and preventing the suffering of patients.

The authors found 25 RCTs comparing antidepressants and placebo for the treatment of depression in palliative care. The primary outcome was efficacy assessed at three time-points. At each time-point antidepressants were more efficacious than placebo:

4-5 weeks odds ratio (OR) 1.93 (1.15-3.42) p = 0.001

6-8 weeks OR 2.25 (1.38-3.67) p = 0.001

9-18 weeks OR 2.71 (1.50-4.91) p = 0.001

The research team concluded:

This review provides evidence that antidepressants are effective in treating depression in palliative care. Their superiority over placebo is apparent within 4-5 weeks and increases with continued use. It is probable that the effect sizes yielded in this review overestimate the efficacy of antidepressants due to biases such as selective reporting and publication. Nevertheless, the magnitude and consistency of the effect suggests genuine benefit.

André started the Mental Elf website in May 2011.
He has worked as an Information Scientist in Mental Health since the late nineties; initially at Oxford University's Centre for Evidence-Based Mental Health and since 2002 as the Managing Director of Minervation Ltd.
He loves blogging, social media and elves! He also has established interests in evidence-based healthcare, usability testing and web design.